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The BRAIN Project

Improving Dementia and Delirium Care Across the Hospital

Introducing BRAIN (Brain-Healthy Care for Acute and Inpatient Environments) — a collaboration between the Alzheimer’s Association, West Health Institute, and GEDC. Follow along as the project advances by joining our mailing list.

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The Challenge

Addressing Cognitive Impairment

Dementia and delirium are among the most common and consequential conditions encountered in emergency departments (EDs) and hospitals. Despite their prevalence, these cognitive impairments are widely under-recognized, inconsistently screened for, and not always well supported by standard ED workflows — especially in departments that are already under significant strain.

Older adults living with dementia are at greater risk of falls, injury, and functional decline when they visit the ED. Importantly, they are also more likely to develop delirium, which is associated with many complications — including higher mortality.

Compounding the challenge, most care environments aren’t designed for adults living with cognitive impairment. Although protocols exist to address them, these practices are not yet the national standard. As a result, hospitals see more preventable admissions associated with unmanaged dementia and delirium, while the human and financial costs keep mounting.

A Look at the Numbers

  • Patients with dementia are 33% more likely to be hospitalized after an ED visit1 
  • Each additional hour of ED boarding increases the likelihood of delirium by 2%2
  • Delirium occurs in 30-50% of hospitalized older adults, including up to 2.6 million cases per year in the United States3 
  • Patients with dementia are admitted for twice as many hospital stays per year4
  • One in three older adults leaves the hospital more disabled than when they arrived5
  1. LaMantia, M. A., et al. (2016). Alzheimer Disease and Associated Disorders, 30(1), 35–40.
  2. Joseph, J. W., et al. (2024). JAMA Network Open, 7(6), e2416343.
  3. Kwak, M. J., et al. (2024). Journal of the American Geriatrics Society, 72(1), 14–23.
  4. Alzheimer’s Association. (2025). 2025 . Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 21.
  5. Joseph, J. W., et al. (2025). Emergency Medicine Clinics of North America, 43, 345–359.

What BRAIN Provides

Enhancing Dementia and Delirium Care Nationwide

BRAIN (Brain-Healthy Care for Acute and Inpatient Environments) was developed to help health systems directly address the challenge of cognitive impairment. By bringing together leading hospitals from across the country, the project explores practical interventions for dementia and delirium in ED and inpatient settings. As successful approaches are shared through collaborative sessions, the BRAIN team will work to formalize and disseminate them. From there, health systems are equipped to transform care — translating what is already known into what is widely practiced.

Leading the Project

ALZ Logo
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How BRAIN Works

Four Workstreams Driving Change

BRAIN weaves together four workstreams to identify, standardize, and share approaches that improve care for patients with cognitive impairment. Explore each one and learn how the initiative works.

Find Exemplary Sites

BRAIN Bright Spots

Key launch sites called Bright Spots test, refine and share promising practices.

Build on What Works

Best Practice Accelerator Community (BPAC)

Virtual sessions bring Bright Spots together to share insights and drive real-world action. 

Standardize Solutions

Toolkit and Resource Development

The BRAIN team translates these insights into concrete, replicable processes and practical toolkits.

Bring It to Scale

Adoption Workshops and Dissemination

New workshops and resources enable sites everywhere to move from awareness to action.  

Find out how BRAIN is making a difference.

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“Patients living with dementia and delirium are among the most vulnerable people entering our hospitals — and frequently among those least able to advocate for the care they need. This is exactly the kind of implementation work that can change what hospitals do and how they do it.”
– Kelly O’Brien, Executive Director Brain Health, West Health
“By bringing together the best evidence, the best practices, and the people committed to change, we can catalyze change and help make brain-healthy care the standard for every patient, every caregiver, and every health system.”
– Christina Shenvi, MD, PhD, MBA

BRAIN Bright Spots

Hospitals Making Real Impact

BRAIN relies on close collaboration with select sites across the country we call Bright Spots. These hospitals are recruited for their success in caring for patients with dementia and delirium. Through structured interviews and deep-dive site work, BRAIN uncovers effective approaches that will inform practical resources like toolkits and adoption manuals. In this way, our Bright Spots will help us turn real-world practices into sharable knowledge.

Best Practice Accelerator Community (BPAC)

Sharing Solutions

National action begins with individual hospitals — and the innovations they contribute. BRAIN connects Bright Spot sites through its Best Practice Accelerator Community (BPAC). During quarterly collaboration sessions led by GEDC, participating sites and clinical experts share knowledge and solve problems in key areas. Insights are then translated into toolkits and replicable processes for national adoption. Take a closer look at how BPAC works.

Sharing Knowledge

Peer-to-peer sessions surface what works best across high-performing sites.

Collaborating

Virtual discussions explore initial insights and how we can act on them.

Focusing Ideas

Ideas are refined across three key areas: delirium screening, ED discharge, and transitions of care.

Creating Resources

Solutions are packaged into resource kits with workflows, checklists, and example order sets.

Scaling

Replicable QI manuals are created for peers to adopt nationwide.

Toolkit and Resource Development

Defining Best Practice

The BPAC sessions produce insights around the best approaches at leading sites. A multidisciplinary design team then steps in, translating the upfront work into concrete processes. The team includes clinical experts, implementation scientists and project leaders. Together, they synthesize findings from Bright Spot interviews, BPACs, and the existing evidence base and into plug-and-play toolkits. Using these resources, hospitals can adopt proven strategies without starting from scratch.

Adoption Workshops and Dissemination

Bringing Solutions to Scale

Once our solutions have been packaged, we share them nationally with peer organizations. BRAIN offers support through workshops and QI manuals designed to help hospitals and health systems implement these practices consistently at scale.

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The BRAIN Project Collaborators

Meet the Team

Alex Fenn, MD

University of North Carolina

Clinical Informatics and Workflow Expert

Olivia Gamboa, MD

Pardee Hospital, NC

Inpatient Expert

Liz Hall, MPH

Alzheimer’s Association

Resource & Content Development Strategy Expert

Alex Ostberg

Alex Ostberg, MPH

GEDC, UNC

Program Manager

Christina Prather, MD

George Washington University

Geriatrics and Palliative Medicine Expert

Christina Shenvi, MD, PhD, MBA

GEDC, UNC

Project Director and Geriatric Emergency Medicine Expert

Chris Waszynski, DNP

Hartford Healthcare and IHI

Geriatrics and Cognitive Impairment Subject Matter Expert